EB病毒(EBV)是一种常见的人类疱疹病毒,具有广泛的临床表现,主要影响淋巴系统。然而,中枢神经系统(CNS)受累,虽然罕见,可能会发生并提出诊断挑战,特别是在有免疫能力的个体中。我们介绍了一个28岁的健康女性,她最初患有流感样疾病,她的症状迅速进展,导致神经缺陷,和改变精神状态。病人的诊断检查,包括病毒组和各种抗体,未能提供决定性的诊断。然而,腰椎穿刺显示脑脊液(CSF)明显异常,包括白细胞计数升高和CSF蛋白升高。神经影像学研究显示皮质下白质的非特异性发现,桥髓交界处,和延长的脊髓损伤。可悲的是,病人的病情迅速恶化,重复成像观察到弥漫性脑水肿,即使在常规治疗后也会导致患者死亡。CSF分析,在顶点实验室表演,EBVPCR意外返回阳性,提示诊断为EBV脑炎或EBV相关性急性播散性脑脊髓炎(ADEM)。该病例突出了在诊断EBV相关中枢神经系统表现时遇到的挑战,特别是在有免疫能力的个体中,这些演讲非常罕见。不典型的临床过程,负面的初步实验室调查,并且缺乏特定的放射学发现进一步使诊断过程复杂化。早期认识和考虑感染的病因,包括EBV,在出现无法解释的脑炎或ADEM样症状的患者中,对于及时干预和最佳患者预后至关重要。
Epstein-Barr virus (EBV) is a common human herpesvirus associated with a wide range of clinical manifestations, primarily affecting the lymphoid system. However, central nervous system (CNS) involvement, although rare, can occur and present a diagnostic challenge, particularly in immunocompetent individuals. We present a case of a 28-year-old healthy female who initially presented with a flu-like illness, her symptoms rapidly progressed, leading to neurological deficits, and altered mental status. The patient\'s diagnostic workup, including a viral panel and various antibodies, failed to provide a conclusive diagnosis. However, lumbar puncture revealed significant abnormalities in cerebrospinal fluid (CSF), including elevated white blood cell count and elevated CSF protein. Neuroimaging studies demonstrated non-specific findings in subcortical white matter, pontomedullary junction, and extended spinal cord lesion. Tragically, the patient\'s condition rapidly worsened, with diffuse cerebral edema observed on repeat imaging, leading to the patient\'s demise even after conventional treatment. CSF analysis, performed at an apex lab, unexpectedly returned positive for EBV PCR, indicating a diagnosis of EBV encephalitis or EBV-associated acute disseminated encephalomyelitis (ADEM). This case highlights the challenges encountered in diagnosing EBV-associated CNS manifestations, especially in immunocompetent individuals, where these presentations are exceedingly rare. The atypical clinical course, negative initial laboratory investigations, and absence of specific radiological findings further complicated the diagnostic process. Early recognition and consideration of infectious etiologies, including EBV, in patients presenting with unexplained encephalitis or ADEM-like symptoms, are essential for timely intervention and optimal patient outcomes.